Community Care Paramedics - Assignment Example

Part A-E Questions ID Part A: Immunisation 1 DTaP vaccine (DAPTACEL), which is administered intramuscularly, is indicated for active immunization against tetanus, pertussis, and diphtheria within children and infant six weeks through six years. The present dosing regimen for DAPTACEL features four dose series, given at 2, 4, 6, and 15-20 months. The contraindications to vaccination include severe hypersensitivity (allergic reaction), progressive neurological disorder, and potential impairment of the immune system; however, it is essential to appreciate that, getting diphtheria, tetanus, or pertussis disease would be highly likely yield to severe problems compared to getting Tdap or Td vaccine. # 1.2 Measles-mumps-rubella (MMR) is mainly transmitted by infected patients who discharge airborne droplet while sneezing or coughing. MMR is given in two doses mainly during childhood, whereby children should be given 12-15 months and the second 4-6 years of age. Some of the risks and side effects linked to MMR include redness, soreness, fever, seizure, encephalitis, and stiffness (Huang, Lu, & Chen, 2011). # 1.3 OPV features mixture of live attenuated poliovirus strains of three serotypes chosen for their capability to mimic to ape the immune response after infection with wild polioviruses. In most cases, 3-4 doses of OPV given at the age of 2, 4, 6-18 months are necessary to generate sufficient levels of seroconversion. Some of the risks and side effects linked to the vaccine include redness and pain at injection site, vague feeling of discomfort, or fatigue (Fiore, Bridges, & Cox, 2009). # 1.4 Tetanus vaccine is utilized for active immunization against tetanus with the core objective being preventing the severe complications linked to the disease. The dose administered intramuscular or subcutaneous is given to infants 6-8 weeks of age or even older, and all people should receive booster injections each ten years throughout their lives. Tetanus vaccine is contraindicated to individuals who manifest a previous systemic hypersensitivity reaction to vaccines. The local reactions at injection site include tenderness, malaise, fever, rash, hypotension, and lymphadenopathy (Fiore, Bridges, & Cox, 2009). # 1.5 Hib or PRP vaccine represents a conjugate vaccine designed for the prevention of invasive disease emanating from the utilization of Hib vaccine. Hib may be administered as part of a combination vaccine and is mainly given in 3-4 doses according to the vaccine used. Hib vaccine is first administered when the child is two months, while the other doses can be administered at 4, 6, and 12-15 months. The risks and side effects linked to Hib vaccine include redness, swelling, or warmth at injection site, and fever (Huang, Lu, & Chen, 2011). # 1.6 Meningococcal Group C (Neisseria meningitis) infection can yield to meningitis and septicemia, as well as other infections such as eye infection and inflammation of the heart. Three doses are required to ensure that the infant develops effective immune response to offer adequate protection against the disease. The side effects linked to the vaccine include mild fever, diarrhoea or vomiting. Immunization should be postponed in the event that, the child manifests a high temperature or serious infection. The vaccine should also be avoided if there is an allergic reaction (Poorolajal, et al., 2010). # 1.7 The Hepatitis B vaccine (under trade name of Recombivax HB and Twinrix) features hepatitis B surface antigen (HBAg) (Huang, Lu, & Chen, 2011). The schedule of immunization encompasses three injections administered at birth, and after 1, and six months. Although, a course may provide lifelong immunity, individuals at risk of infection should receive a single booster dose of vaccine five years consequent to primary immunization. The adverse risks linked to the vaccine are limited and mild and may entail soreness and erythema, fatigue, and malaise. # 1.8 Hepatitis A vaccine (HAVRIX) is mainly indicated for active immunization against hepatitis A virus. The initial immunization ought to be administered two weeks before the expected exposure to HAV. HAVRIX is mainly administered via intramuscular injection. HAVRIX is contraindicated for persons with severe allergic reaction consequent to the administration of the first dose. The adverse reactions linked to the vaccine include soreness, redness, drowsiness, loss of appetite, and headache (Fiore, Bridges, & Cox, 2009). # 1.9 Zostavax represents a live attenuated virus vaccine, which is indicated for the prevention of herpes zoster (shingles). However, the vaccine is not indicated in the treatment of neuralgia and should not be utilized for prevention of primary varicella infection. The vaccine is mainly administered subcutaneously in a single dose. Zostavax is contraindicated for persons with a history acquired immune-deficiencies and those with a history of anaphylactic reaction. The side effects connected to the vaccine include polymyalgia rheumatic, cardiovascular events, and asthma exacerbation (Vila-Corcoles & Ochoa-Gondar, 2013). # 1.10 Pneumococcal vaccination (PPV23) is indicated for individuals predisposed to pneumococcal infection, as well as immunocompromised children irrespective of routine childhood vaccinations. Pneumococcal conjugate vaccine (PCV13) is administered for all children aged less than five years, and at-risk adults 19 years or older. The side effects associated with the disease include redness and pain at injection site, fatigue, headache, or discomfort. # 1.11 Rotavirus vaccine protects against RV and contains five live rotaviruses isolated from human and bovine hosts. The vaccination series detail three ready-to-use liquid doses of the vaccine administered orally at 6-12 weeks of age and 4-10 week intervals, while the third dose is given after 32 weeks of age. The vaccine is contraindicated for those with previous hypersensitivity to any aspects of the vaccine. Precautions should be taken to infants who are immunocompromised. Some of the adverse effects of the vaccine include vomiting, diarrhoea, irritability, and fever. # 1.12 The Fluenz vaccine is administered intramuscularly, but may also be administered through deep subcutaneous injection, and nasal spray. Children who are not clinically at risk require one dose, while at-risk population should receive a second dose. Precautions should be observed for immunocompromised individuals owing to intercurrent illness, HIV infection, or premature birth (Fiore, Bridges, & Cox, 2009). Contraindications to influenza vaccination detail those individuals who manifest anaphylactic reaction to a previous dose (Ojo, et al., 2010). The adverse effects of the vaccine include angio-oedema, urticaria, encephalomyelitis, neuritis, and neuralgia (Plotkin, Fine, Eames, & Heymann, 2011). # 2 Immunization plays a crucial role in the eradication of disease and reductions in the incidence of vaccine-preventable diseases. However, vaccination can yield to minor and seldom, serious side effects. Despite the concerns regarding vaccine safety, vaccination remains the safest option, rather than accepting the risks posed by the diseases they prevent. Largely, the advantages of vaccination surpass potential risks. Indeed, failure to vaccinate heightens the risk to both individuals and the society (Plotkin, Fine, Eames, & Heymann, 2011). # 3 The recommended vaccine schedules for children detail HepB at birth to two months; RV, DTaP, Hib, PCV, and IPV when the child is two months; RV, DTaP, Hib, PCV, and IP at four months; RV, DTaP, PCV, and Hib at six months; and, Hib, PCV, IPV, MMR, Varicella, HepA, DTaP, and Influenza (yearly) from 12 months to eighteen months. Two dosages provided at least four weeks apart is mainly recommended for those children aged six months to eight years. Two dosages may be required for lasting protection with the first vaccine given between 12 months and 23 months of age, while the second dosage should be given 6-18 months after the initial dose (Plosker, 2013). # 4 Recommendations for vaccinations apply to individuals that manifest a heightened risk of developing certain infections. The recommended vaccination of influenza is mainly one dose annually for adults. The vaccine Tetanus, pertussis, diphtheria (Td/Tdap) is given 1-time dose of Tdap, which should be boosted with Td each 10 years. The Varicella is given two doses (19-65 years), while HPV vaccines are given in three doses in 19-26 years. MMR vaccine is given between 19- 50 years in one of two doses, while PCV13 vaccine is given in one dose between 19-65 years. The Meningococcal, Hepatitis A, Hepatitis B, and Hib vaccine dosages vary from 1 dose to 3 doses from age 19 to 65 years (Plosker, 2013). # 5 Herd immunity represents a form of immunity, which manifests when the vaccination of a considerable portion of a population avails a measure of protection for those who are yet to develop immunity (Plotkin, Fine, Eames, & Heymann, 2011). Herd immunity occurs when a significant percentage of the population is protected via vaccination against a bacteria or virus, which renders it difficult for the disease to spread because there are few susceptible individuals left to infect. # 6 Aboriginal and Torres Strait Islander Children living within certain areas of Australia are a greater risk of getting infected with some diseases such as flu, TB, and pneumonia. Hence, Aboriginal and Torres Strait Islander children must be given extra protection against the outlined infections, besides the vaccines recommended for all children and adults (Ojo et al, 2010). Part B: Common Respiratory Complaints # 1 Upper respiratory tract infection (URI) can be cited as the most prominent acute illness evaluated within the outpatient setting. Lower respiratory tract infection (LRTI) represents infections that are below the level of the larynx and may encompass bronchitis, bronchiolitis, pneumonia, and laryngotracheobronchitis (croup) (Gageldonk-Lafeber, et al., 2007). The presentation of LRTI features fever and may be preceded by a characteristic viral URTI. Audible wheezing is not frequently manifest in LRTI and stridor or croup implies URTI, foreign body inhalation, or epiglottitis. # 2 Some of the causes of respiratory distress include conditions that impact on muscles and nerves, which control breathing such as stroke, spinal cord injuries, and muscular dystrophy. Respiratory distress may also be caused by drug or alcohol overdose, acute lung injuries, and lung diseases and conditions such as COPD, pneumonia, cystic fibrosis, and lung injuries such as harmful fumes or smoke (Rudan, et al., 2008). # 3 Some of the causes of respiratory complaints that are potentially dangerous include lung injuries and disease, drug or alcohol overdose, acute conditions such as COPD, pneumonia, ARDS, and cystic fibrosis. Other causes of respiratory complaints that are potentially dangerous include virus infections such as respiratory syncytial among the elderly, individuals with cardiopulmonary diseases, and immunocompromised hosts (Rudan, et al., 2008). # 4 Assessment question for respiratory complaints should centre on past medical history such as the use of inhalers, steroids, and drugs that influence respiratory disease such as ACE inhibitors. Questions should also dwell on occupation history, as well as on social history can provide insights into the patient’s lifestyle, hobbies and pets, smoking history, and sexual history. It is also essential to enquire about family history since some respiratory diseases have a genetic component such as emphysema and cystic fibrosis. # 5 Physical assessment findings are gained via the use of diagnostic techniques including inspection, palpation, percussion, and auscultation. Critical elements of the physical examination when examining respiratory complaints include an evaluation of the respiratory rate and pattern. Abnormal breathing patterns may be indicative of respiratory problems (Rudan, et al., 2008). # 6 The flu and the common cold represent respiratory illnesses, which are caused by diverse viruses. In most cases, flu is worse relative to the common cold, especially because the symptoms such as fever are more prominent and intense. Colds, on the other hand, are milder relative to flu and individuals with colds are highly likely to have runny or stuffy nose (Rudan, et al., 2008). # 7 Some of the complications linked to the common cold include serious infections such as sinusitis, ear infection, and bronchitis, which necessitate administration of antibiotics. Other complications linked to the common cold include asthma attacks, chronic bronchitis, and emphysema in which the patient may experience respiratory symptoms long after the cold. # 8 Some of the potential complications linked to influenza include pneumonia, myositis, bronchitis, central nervous system disease, pericarditis, sinus infections, bronchitis, and ear infections. Pneumonia can be cited as the most prominent and most severe complication, especially because it can be fatal for older adults (Eloy, et al., 2011). # 9 Sinusitis represents an inflammation of the membranous lining of the sinuses. Sinusitis is characterized by pain on palpation of the sinuses, oedema and erythema of the nasal mucosa. Sinusitis can yield to systemic and local complications (Eloy, et al., 2011). Sinusitis can yield to local complications including orbital cellulitis, orbital abscess, subperiosteal abscess, subdural empyema, and meningitis. # 10 Sore throat represents a symptom emanating from the inflammation of the upper respiratory tract. Bacterial pharyngitis mainly caused by streptococcus bacteria that can be confirmed through diagnostic tests and treated with antibiotics (Aalbers, et al., 2011). Viral pharyngitis can be regarded as the most prominent cause of sore throat. The presentation of pharyngitis entails fever, sore throat, swollen lymph nodes, and joint pain. # 11 Strep throat represents bacterial throat infection, which makes the throat feel scratchy and sore. Some of the complications linked to strep infection encompass sinuses, middle ear infection, retropharyngeal abscess, and toxic shock syndrome. The other complications draw from the body’s immune response to strep bacteria including rheumatic fever, and PANDAS (Eloy, et al., 2011). # 12 Croup represents a prominent childhood disease caused by upper respiratory tract infection, as well as viral infection. Viral upper respiratory tract infection (URTI) yields to nasopharyngeal inflammation. The inflammation may also impair the movement of the vocal cords yielding to further compromise of the airway. # 13 Complications that result from Croup are rare; however, children may manifest airway obstruction, which may yield to respiratory arrest and severe breathing difficulty. Croup may also yield to secondary infection that develops as a result of the original viral infection. The secondary infection can potentially yield to pneumonia, middle ear infection, lymphadenitis, and bacterial tracheitis. # 14 Pneumonia represents a significant cause of mortality and morbidity among all ages. Pneumonia can be caused by multiple organisms and can manifest as a complication or core condition of other diseases (Rudan, et al., 2008). The clinical presentation of bacterial pneumonia differs. The presentation of pneumonia includes symptomatic cough, whooping sound, and chest pain. # 15 Some of the complications associated with pneumonia include lung abscess, pleural effusion, meningitis, septic arthritis, endocarditis or pericarditis, and difficulty breathing. The complications may impair capability of the patient to breath in adequate oxygen, which may trigger other complications (Mahabee-Gittens, et al., 2005). # 16 Bronchiolitis represents an acute inflammatory injury of the bronchioles, which is mainly caused by a viral infection. The condition may manifest in individuals of all ages. Bronchiolitis yields to inflammatory submucosal oedema with smooth muscle spasm within lower respiratory tract (Mahabee-Gittens, et al., 2005). # 17 Some of the complications linked to bronchiolitis encompass dehydration, cyanosis, apnea, respiratory failure, and fatigue. Respiratory failure may necessitate insertion of a tube into the trachea to aid breathing. # 18 Asthma exacerbations represent exaggerated lower airway response to environment exposure occasioned by virus infection. The inflammatory infiltrate varies from the allergen, which implies that the pathogenesis of the disease is distinct from the one manifest in chronic disease. # 19 Some of the asthma complications include pneumonia, lung collapse, respiratory failure, and status asthmatics. Asthma complications may also yield to emergency room visits and hospitalizations. Women who have asthma may register an increase within the risk for certain complications of pregnancy such as high blood pressure (van Woensel, van Aalderen, & Kimpen, 2003). # 20 Viruses usually cause most URIs with coronavirus, adenovirus, influenza virus, parainfluenza virus, and rhinovirus (van Woensel, van Aalderen, & Kimpen, 2003). Field treatment of URIs should be directed at maximizing relief of the majority of prominent symptoms. A dose of antibiotics, decongestants, and anti-inflammatory drugs should be administered to relieve symptoms such as headache, malaise, and fever. # 21 Urgent care of croup hinges on the degree of respiratory distress. The evaluation of a child who manifests significant respiratory distress should centre on guaranteeing the patency of the airway and sustenance of effective oxygenation and ventilation. Oral corticosteroids can be utilized to minimize inflammation and swelling. This treatment is appropriate for those manifesting the worst symptoms and works in one to two hours. # 22 The core symptoms of acute bronchitis include cough, sore throat, nasal congestion, soreness, fatigue, and chest discomfort. The field treatment of bronchitis caused by bacterial infection includes antibiotic administration. Other interventions include establishing the patency of the airway and sustenance of effective oxygenation and ventilation (Mahabee-Gittens, et al., 2005). # 23 Antibiotic therapy can be cited as one of the field management plan for a patient with bacterial pneumonia (Mahabee-Gittens, et al., 2005). Patients with mild shortness of breath may require supplemental oxygen accompanied by nasal cannula may be necessary for ventilator support. Patients manifesting respiratory failure may require high oxygen concentrations provided through endotracheal intubation and ventilation. Intravenous crystalloid bolus in the field may be given to patients with and hypotension and hypotension (Lin et al, 2010). # 24 Acute respiratory tract infections can be regarded as a critical public health problem. Learning more about respiratory complaints may help the patient to manage his or her symptoms better, limit attacks, and react quickly when respiratory attacks manifest. Patient education can aid patients to recognize the signs and symptoms of the respiratory condition, and avoid factors that may trigger such attacks (Lin et al, 2010). # 25 Close to 40% and 60% of children are exposed to tobacco smoke at their home, which heightens the susceptibility to sudden infant death syndrome, lower respiratory tract illness, and middle ear disease and exacerbate asthma (Lin, et al., 2010). There is a need for a well-structured future intervention program targeting pre-school children’s mothers so as to protect children from second-hand smoke exposure hazards. # 26 Compounds such as acid anhydrides, epoxy resins, and isocyanates can act as non-specific irritant within high concentrations, as well as predispose some subjects to allergic hypersensitivity. Respiratory irritants encompass substances that yield to inflammation of the airways after inhalation. Toxic chemicals mainly yield to parenchymal damage, and also act as respiratory irritants (Lin et al, 2010). Part C: Chest Pain # 1 Chest pain may be caused by minor problems such as stress, heart attack, panic attack, and pulmonary embolism. The digestive causes of chest pain encompass heartburn, gallbladder or pancreas problems, and swallowing disorders. Chest pain may also result from lung-related causes such as collapsed lung, pleurisy, pneumonia, pneumothorax, pulmonary embolism, and pulmonary hypertension. # 2 Chest pain may be caused by serious causes such as heart attack, which manifests when artery supplying oxygen to the heart muscle is blocked. Conditions such as angina, myocardial infarction, aortic dissection, pulmonary embolism, and tension pneumothorax can be threatening to the patient (Jones, et al, 2006). # 3 Crucial questions are essential in order to make an accurate diagnosis include nature and intensity of chest pain, location and radiation of the chest pain, relieving and aggravating factors, and past medical history (enquire about history of angina, levels of lipids, operations or illnesses). Other important questions relate to occupational, family, and social history, especially lifestyle such as smoking, cholesterol problems, and overweight (Jones, et al, 2006). # 4 Crucial historical elements to guide the tempo of presentation of symptoms encompass present frequency and change within frequency and severity of angina (Jones, et al, 2006). The critical prognostic elements on physical examination encompass any proof of acute congestive heart failure, a new or deteriorating MR murmur, or systemic hypotension, especially in an episode of severe pain. # 5 The pathophysiology of angina begins with the heart muscle failing to receive a sufficient flow of blood. Several reasons account for the inadequate flow of blood including a blockage within one of the coronary arteries, which restricts blood flow and oxygen to the heart muscle (Jones, et al., 2006). The narrowing and blockage of arteries may be caused by lifestyle factors such as smoking, overweight, and insufficient exercise. A diet with saturated fats may clog up the arteries and hinder blood and oxygen from reaching the heart muscles. # 6 The symptoms of Angina differ among individuals, and may range from pain, discomfort or tightness, and ache (Tarkin & Kaski, 2013). The pain may be last between 30 seconds and half an hour and is mainly alleviated with sublingual nitroglycerin. The manifestation of changes within the frequency, severity, quality, or duration of the pain or precipitating factors indicates unstable angina that necessitates urgent medical attention. # 7 Grade I. Angina manifests only with strenuous, quick, or lengthy exertion at work or recreation. Grade II. Angina manifests with slight limitation of ordinary activity such as walking uphill, or climbing more than one flight of stairs. Grade III. Angina manifests with marked limitation of normal physical activity occasioned by minor tasks such as climbing a flight of stairs or walking one to two blocks. Grade IV. Angina may manifest at rest rendering it impossible for one to undertake any physical activity without experiencing discomfort. # 8 The listings are significant for prioritizing of patients for treatment or transport based on the severity of the angina. Primary triage that is risk-based is undertaken at the scene and is meant to highlight and immediately treat life-threatening condition or disease. Patients manifesting unstable angina with intermediate or at high risk of complications should receive beta blocker, nitroglycerin, and aspirin and be hospitalized for careful monitoring # 9 Some of the conditions that can worsen angina include coronary artery disease and atherosclerosis, which causes the arteries to narrow or get blocked (Gandhi, Lampe, & Wood, 1995). The precipitating conditions for unstable angina may heighten myocardial oxygen demand such as physical exertion or minimize myocardial oxygen supply such as anaemia, spasm of an epicardial coronary artery, or development of platelet-rich thrombus on fissure plaque. # 10 Nitrites are crucial for dilatation of coronary arteries, which yields to heightened perfusion of ischemic zones. The dilation of the systemic venous system is likely to minimize preload, ventricular volume, and reduction within pulmonary capillary wedge pressure. Beta-blockers minimize oxygen demand by stabilizing heart rate, as well decreasing blood pressure, contractility, sinus node firing rate, AV conduction, cardiac oxygen demand, and incidence of arrhythmias within acute myocardial infarction (Kamp, et al., 2010). Calcium channel blockers: channel blockers Calcium minimize oxygen demand by minimizing blood pressure, afterload, and contractility, which is attained through vasodilation of coronary arteries and arterioles. Anti-platelet and anticoagulant inhibit or break up blood clots, whereby anti-platelet drugs prevent blood platelets from joining or sticking together. However, anti-platelets drugs carry the risk of bleeding. # 11 The field treatment entails checking airway, breathing, and circulation and beginning cardiac life support if necessary. Acute management of angina may necessitate supplemental oxygen, monitoring of oxygen saturation and vital signs, establishing intravenous access, 12-lead electrocardiogram, and cardiac stress testing and catheterization. # 12 Patient education may centres on recognizing symptoms of angina, ways of accessing emergency medical services and prompt use of medication. Patient education can also centre on lifestyle changes since heart disease is usually the underlying cause of angina. As such, patients can reduce or prevent angina by targeting heart disease risk factors such as smoking, high cholesterol, poor diet, lack of physical activity, excess weight, and stress. Part D: Shortness of Breath # 1 Chronic shortness of breath is mainly caused by asthma, heart dysfunction, COPD, and obesity. Some of the lung problems linked to shortness of breath include lung cancer, croup, pulmonary edema, pulmonary fibrosis, pulmonary hypertension, and, tuberculosis. Heart problems including heart failure, pericarditis, heart arrhythmias, and cardiomyopathy may also cause shortness of breath (Braen, 2011). # 2 Some of the causes of shortness of breath that are potentially serious include asthma, pneumonia, heart disease, nervous system problems, COPD, and pulmonary embolism. Other lethal causes of acute shortness of breath include collapsed lung (pneumothorax), blood clot or other blockages within an artery, asthma, and heart failure. # 3 It would be crucial to ask how long the patient had the shortness of breath (acute or chronic), the onset of shortness of breath gradual or sudden (if acute it may imply lung collapse, pneumothorax, pulmonary embolism and if chronic it may imply congestive cardiac failure), what renders the shortness of breath worse (such as exercise), history of bleeding (bloody stools, vomiting blood may imply anemia), past medical history (prior respiratory disease, heart problems, high blood pressure, or rheumatic fever), and medications (medications may trigger lung problems and ensuing shortness of breath such as cytotoxic agents). # 4 The critical elements of the physical examination when assessing dyspnea include respiratory rate and pattern. Other elements include on physical examination encompass any proof of pneumothorax, a new or deteriorating shortness of breath, or systemic heart dysfunction. # 5 Multiple mechanisms give rise to the qualitatively diverse sensations of dyspnea, which means that dyspnea in most patients arises from a combination of mechanisms (Manning & Mahler, 2001). For instance, airway inflammation, vagal stimuli emanating from bronchoconstriction and neuroventilatory dissociation may all contribute in dyspnea among asthma patients. # 6 The operational objective of the triage scale, which range from Level I (resuscitation) to level V (non-urgent), centres on reducing the time required to see a physician. The objectives of triage centre on availing ongoing assessment of patients, and speedily identifying patients with urgent, life threatening conditions (Wood & Garner, 2012). Part E: Hypertension # 1 In the past decade, the management of hypertension has undergone changes owing to the recognition that there is no level below which elevated blood level yields to no threat to the health. Some of the crucial information to obtain from chronic hypertensive patient dwells on physical examinations, treatment and monitoring of the patient’s renal and cardiovascular conditions. # 2 Complications of hypertension represent clinical outcomes, which emanate from persistent elevation of blood pressure. Chronic hypertension can yield to heightened risk of life threatening problems such as heart attack and stroke. The complications of hypertension affecting the brain include subarachnoid haemorrhage or intracerebral haemorrhage. # 3 High blood pressure represents a common condition in which elevated blood pressure may ultimately cause health problems such as heart disease. Peripheral resistance and cardiac output remain two determinants of arterial pressure and is shaped by stroke volume and heart rate directed by myocardial contractility. # 4 Heightened systemic vascular resistance, heightened vascular stiffness, and increased vascular responsiveness to stimuli are at the heart of pathophysiology of hypertension (Egan, Zhao, & Axon, 2010). It is only after invariable asymptomatic period that persistent hypertension develops into complicated hypertension that yields to damage to organs, heart, kidneys, retina, central nervous system, and aorta is manifest. # 5 The approach for a patient with newly diagnosed elevated blood pressure includes anti-hypertensive therapy tailored and personalized as per health profile. The other approach relates to non pharmacologic interventions that encompass lifestyle modifications such as increased physical activity. Effective management of hypertension is central to managing renal disease and cardiovascular disease (Viera & Hinderliter, 2009). # 6 Question on family history and lifestyle can give insights into predisposing factors to the hypertension. The questions on family history are meant to confirm the presence of high blood pressure, risk or aggravating factors for hypertension, evaluate the effects of high blood pressure on the patient. # 7 Some of the essential physical elements to examine in a patient with hypertension include measurement of weight, blood pressure, waist, neurological assessment, and height. The other examination relate to an examination of the neck for enlarged thyroid, abdomen for abdominal bruits, retina, heart, and pulse in various areas of the body. # 9 Long-term control of hypertension is crucial since it safeguards against cardiovascular complication (Foex & Sear, 2004). Some of the situations that may necessitate consultation with a primary care provider encompass instances in which the patient has developed complications such as stroke and kidney failure. Acute hypertension in asymptomatic patients may require immediate treatment, which makes consultation with emergency personnel necessary. # 10 Some of the information that is necessary to report back to the primary care provider relate to lifestyle modifications that the patient has managed to implement. The other information may relate to the necessity to increase drug use, or substitute another drug to counter inadequate response from the patient. # 11 The “step care approach” dictates how, which and when hypertension medication should be prescribed for the treatment (Franx, et al., 2012). Diuretics can be cited as the preferred first choice for initial treatment, but beta-blockers has also become the first choice. # 12 Diuretics mainly inhibit electrolyte reabsorption from the lumen, enhance osmolarity, and heighten water excretion. The efficacy of the Diuretics draws from their capability to minimize blood volume, cardiac output, and systemic vascular resistance. The side effects of diuretic entail potassium loss, hypokalemia, metabolic acidosis, metabolic alkalosis, dehydration, electrolyte disturbances, metabolic disturbance, and renal failure caused by high doses of diuretics. # 13 Beta blockers represent class of drugs, which target the beta receptors situated on the cells of heart muscles, airways, arteries, kidneys, smooth muscles, and other muscles that constitute sympathetic nervous system. The adverse impacts of beta-blockers entail nausea, dyspnea, cold extremities, hypotension, heart failure, dizziness, heart block, hallucinations, sexual dysfunction, and erectile dysfunction. # 14 Calcium channel blockers represent dihydropyridines and non-dihydropyridines that yield to vasodilation of the peripheral blood vessels, as well as coronary arteries, but with less reduction within heart rate. # 15 Angiotensin converting enzyme (ACE) inhibitors represent hypertension drugs, which widen or dilate the blood pressure in order to enhance the amount of blood that the heart pumps, while at the same time minimizing blood pressure. The side effects of ACE inhibitors entail dizziness, high potassium levels, kidney failure, diarrhoea, and rash. # 16 The other drugs used in outpatient management o hypertension encompass adrenergic blockers, which impact on the sympathetic nervous system hormones, which generate the fight or flight response. Alpha blockers, on the other hand, yield to vasodilation of the peripheral vessels and minimize blood pressure. # 17 Patients should be informed about their disease about the nature, complications, and overall mortality and morbidity. Adherence to the management of the disease hinges on patient awareness, benefit of treatment to blood pressure control, as well as alleviation of cardiovascular risk (Sarafidis, et al., 2008). Educating patients on the significance of non-pharmacologic interventions for effective hypertension control can be regarded as a critical component of controlling cardiovascular risk. # 18 The percentage of hypertensive patients within Australia receiving adequate treatment is about 32% of 4.6 million Australians aged 18 years and above (Heart Foundation, 2012). Some of the prominent barriers to hypertension control include disagreement with clinical recommendations, lack of knowledge on hypertension, support constraints, stress, depression, and anxiety that impede or delay adoption of a healthier lifestyle, priority setting barriers, and limitation of the health system (Siegel, 2005). Some of the barriers can be remedied through accommodation of patient differences, attaining consensus in practice, and tackling systematic barriers. References Aalbers, J., et al. (2011). Predicting streptococcal pharyngitis in adults in primary care: a systematic review of the diagnostic accuracy of symptoms and signs and validation of the Centor score. BMC Med., 9, 67. Braen, G. R. (2011). Manual of emergency medicine. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins. Egan, B. M., Zhao, Y., & Axon, R. N. (2010). US trends in prevalence, awareness, treatment, and control of hypertension, 1988-2008. JAMA, 303 (20), 2043-50. 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